According to the results of a study conducted in India, an inexpensive approach to cervical cancer screening produced significant reductions in cervical cancer incidence and mortality. These results were published in the Lancet.
Worldwide, an estimated 231,000 women die of cervical cancer each year, with 80% of those deaths occurring among women in developing countries. Barriers to effective cervical cancer screening in developing countries include the cost of Pap testing and follow-up care, poor infrastructure, and inadequate quality control.
A screening procedure that has the potential to overcome several of these barriers is visual inspection with 4% acetic acid (VIA). With VIA, the cervix is examined with the naked eye and a bright light after applying 4% acetic acid. The acetic acid makes abnormal areas of the cervix appear white.
The efficacy of VIA screening was evaluated in a study in India. The study enrolled women between the ages of 30 and 59 years. A total of 49,311 women were assigned to one round of VIA screening and 30,958 women were assigned to standard care. Women in both groups were educated about cervical cancer prevention, early detection, and treatment.
If VIA detected cervical abnormalities, women underwent immediate colposcopy (examination of the vagina and cervix with a specialized instrument called a colposcope) and, when appropriate, treatment with cryotherapy (freezing of the abnormal area). Women with cervical abnormalities that were too extensive for cryotherapy were referred to another center for treatment with a loop electrosurgical excision procedure (LEEP).
- Roughly 64% of the women assigned to VIA received VIA.
- Among the women who underwent VIA, 3,088 (10%) had a positive (abnormal) VIA test. High-grade precancerous changes to the cervix or cervical cancer was confirmed in 285 of the 3,088 women who had tested positive on VIA.
- After seven years of follow-up, women assigned to the VIA group were 25% less likely to develop cervical cancer and 35% less likely to die of cervical cancer than women in the comparison group.
The researchers concluded: “VIA screening, in the presence of good training and sustained quality assurance, is an effective method to prevent cervical cancer in developing countries.”
 Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bulletin of the World Health Organization. 2001;79:954-962.
 Sankaranarayanan R, Esmy PO, Rajkumar R et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. Lancet. 2007;370:398-406.
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